Population Health | Singapore National Eye Centre

Overview

The Population Health Research Group (PHR) is the translational, population eye research unit at the Singapore Eye Research Institute led by Prof Ecosse Lamoureux and Deputy Heads Assoc Prof Ryan Man and Dr Preeti Gupta. The unit conducts multidisciplinary research spanning sensory health, healthy ageing, patient-reported outcomes and health services research to improve patient-centred outcomes, clinical practice and population health. Specifically, PHR’s research investigates the epidemiology, determinants, and consequences of vision, hearing and olfactory impairment, and the impact of age-related sensory decline on cognition, mobility, frailty, sarcopenia, bone health, sleep, falls and quality of life (QoL) across the ageing trajectory. In parallel, the unit is involved in the development, validation and implementation of ocular disease-specific, AI-driven patient-reported outcome measures (PROMs), operationalised using a ‘smart’ algorithm that targets questions to a respondents’ level of QoL trait being measured. PHR translates research findings into improved real-world management and treatment strategies for major eye diseases, particularly Diabetic Retinopathy (DR), Glaucoma, and Age-related Macular Degeneration (AMD). Together, these programmes position the PHR Unit at the interface of population health research, clinical practice, implementation, and health policy.

Our Vision

To advance population health and patient-centred outcomes (PRO) research, through innovative investigations into sensory health, healthy ageing, and AI-driven PROMs development, validation, and implementation.

Our Mission

Through our integrated programme of research, we aim to:

Detect and prevent sensory deterioration
Develop and validate novel QoL instruments to accurately measure patient-reported outcomes
Advance the understanding of the connection between age-related sensory loss, cognition, musculoskeletal, and healthy ageing through multidisciplinary research
Inform evidence-based clinical practices and eye healthcare delivery, leading to healthcare policies and public health strategies

About the Population Health Research Group

Established in April 2013, the PHR is a multidisciplinary team of clinician scientists, biostatisticians, research coordinators, and research administrators from diverse range of scientific backgrounds, including ophthalmology, epidemiology, biostatistics, public health, psychology, psychometrics, ageing research and health services research. Under the oversight and mentorship of Prof Ecosse Lamoureux, the group is headed by a core team of two clinician-scientists (Assoc Prof Ryan Man and Dr Preeti Gupta), two research associates, a biostatistician, an administrator and supported by more than 15 clinical research coordinators (CRCs) across three major research programmes.

Programmes of Research

Aging and Sensory Epidemiology

Our epidemiology and ageing research programme investigates the clinical, biological, musculoskeletal, neurological and psychosocial determinants of age-related sensory decline and healthy ageing in contemporary older Chinese, Malay and Indian Singaporeans. Through comprehensive longitudinal phenotyping, we seek to better understand the epidemiology, risk factors, economic burden, patient-centred consequences and biological mechanisms of vision, hearing and olfactory impairment, and their impact on frailty, sarcopenia, cognition, mobility and quality of life. Our projects include:

The PopulatION HEalth and Age-Related SEnsory Decline PRofilE study - PIONEER I & II
Understanding the relationship between visual decline and age-related muscle mass loss (assessed using Creatinine – Cystatin C Ratio (CCR)) in elderly Singaporeans
Integrating PIONEER and TRUST data to advance healthy ageing: A linked data approach to understanding sensory and cognitive decline, fracture burden, and cardiovascular risk in older adults in Singapore
Establishing Singapore-specific, sex- and ethnicity-specific DXA-derived reference values for low muscle mass
Building a thematic research data twin for ageing research by integrating PIONEER sensory biological data with eHINTS clinical variables
A study on sensory loss and its effects in ageing on dementia and frailty (STEADFAST STUDY)

PROM and CAT Development, Validation and Implementation

Our world-class programme of PRO research develops, validates, and implements cutting-edge PROMs that assess the impact of diseases and treatments from the patients’ perspective. Our computerized adaptive test (CAT) suite delivers comprehensive and precise QoL measurement in under two minutes per domain, making it ideal for use in clinical care, research trials and busy health care settings. Several of our CATs have been successfully implemented at tertiary eye care centres in Singapore and overseas. Some of the current projects include:

Doubling the measurement potential of an adaptive Age-related Macular Degeneration (AMD) quality of life questionnaire: Development of an integrated utility assessment module (Mac-U)
Bridging physician and patient priorities: Establishing Actionable quality of life Metrics for glaucoma management (BEAM)
Evaluating the REal-World PAtient-ReporteD and economic impact of combined minimally invasive glaucoma and cataract surgery (REWARD)
Implementation of fast, precise, and novel eye-specific, quality of life Computerized Adaptive Tests (CATs) at tertiary eye clinics in Singapore
Evaluating the agreement and ReliAbility of novel Patient-rePorted Outcome measuRes powered by smart technology: the RAPPORT study
Development and validation of quality-of-life item banks and Computerized Adaptive Testing systems for type 2 diabetes (DiabCAT)
Development and validation of quality-of-life item banks and Computerized Adaptive Testing systems for AMD (MacCAT)

Sensory and Cognitive Interactions

Our research focuses on the relationship between sensory decline and cognitive impairment primarily focuses on determining causality, shared risk factors, and the cumulative clinical, patient-reported and economic burden of combined sensory and cognitive deterioration. Currently, the cognitive screeners that are available and neuropsychological test batteries rely heavily on visual inputs, which may result in elevated false positive rates in cognitive impairment diagnoses, so we are developing and validating a vision-independent neurocognitive test battery. Our projects include:

Validation of the VISually Independent test battery Of NeuroCognition (VISION-Cog): a novel tool to assess cognitive impairment in older adults with visual impairment
Determining the longitudinal impact of cognitive impairment on vision loss in a multi-ethnic Asian population
Synergistic impact of visual and cognitive impairments on health-related quality of life in a multi-ethnic Asian population
The bi-directional relationship between vision and cognition: a systematic review and meta-analysis
Combined Hearing and Vision Interventions for Cognitive Health in Older Adults with Sensory Impairment (COACHES)

Collaborations

Aging Centre, Duke University, USA
Centre for Ageing Research and Education, Duke-NUS (CARE)
Centre for Eye Research Australia, University of Melbourne, Australia
Centre for Healthy Aging, National University Hospital Singapore
Centre of Quantitative Medicine, Duke-NUS School of Medicine
Clinical Nutrition Research Centre (CNRC), Singapore
Department of Nuclear Medicine & PET, Singapore General Hospital
Department of Otolaryngology, Head & Neck Surgery Singapore
Ethereum Zurich, Switzerland
Gloucestershire Eye Unit, UK
Health Services System Research, Duke-NUS School of Medicine
International Consortium of Health Outcomes Measurement (ICHOM)
MAPI Research Trust
Massachusetts Eye & Ear Hospital, USA
Modus Outcomes
National Dental Centre, Singapore
National Neuroscience Institute, Singapore
Novartis, Spain
Queensland University of Technology, Australia
Saw Swee Hock School of Public Health, National University of Singapore
Sensory Nutritional Science
Singapore Institute of Clinical Sciences
Singapore National Eye Centre (SNEC)
SingHealth and National Healthcare Group Polyclinics
The Singapore Advanced Imaging Laboratory for Ocular Research (SAILOR)
Toho University School of Medicine, Japan
University of California, Berkeley
University of Cambridge, Psychometrics Centre
University of Sydney, Australia
Wilmer Eye Institute, Johns Hopkins University
Yong Loo Lin School of Medicine, National University of Singapore

Publications (Most Recent 20)

Grgic J, Tey SL, Huynh DTT, Low YL, Pedisic Z, Schaller N, Wazny VK, Wang W, Saito Y, Rannan-Eliya RP, Ghattas H, Chaaya M, de Leon CM, Gupta P, Lamoureux EL, Subramaniam M, Abdin E, Malhotra R, Chan A, Tumenbayar B, Luvsandavaajav O, Enkhtuvshin B, Mansor N, Awang H, Maier AB. Comment on 'Asian Reference Values for Handgrip Strength, Gait Speed, Five-Times-Sit-to-Stand Test, Muscle Mass and Calf Circumference' by Grgic et al.-The Authors' Reply. J Cachexia Sarcopenia Muscle. 2026;17(4):e70327.
Chandran M, Wong CMJ, Helgason B, Leong YE, Chan A, Malhotra R, Gupta P, Jha D, Praveen AD, Tan DYZ, Choo HMC, Lamoureux EL. Revisiting the Osteoporosis Self-assessment Tool (OST): Evidence from a Multi-cohort Study in Asia Supporting Age-dependent Thresholds. Osteoporos Int. 2026 Jun 26. doi: 10.1007/s00198-026-08123-1. Online ahead of print.
Yee H, Ho AXY, Wong CMJ, Tan WL, Fenwick EK, Gupta P, Ng ASL, Vu TA, Doshi K, Lamoureux EL, Man REK. Evaluating the Acceptability and Pilot Diagnostic Accuracy of a Visually Independent Test Battery of Neurocognition (VISION-Cog). Med Sci (Basel). 2026 Jun 24;14(3):344.
Peng Q, Xue CC, Chua K, Li H, Nusinovici S, Soh ZD, Gupta P, Leem AY, Yu MCY, Sabanayagam C, Rim TH, Zhu Z, Lamoureux E, Cheng CY. Retinal Biological Age Correlates with Bone Mineral Density and Fracture Risk Score and Predicts Incident Osteoporosis. PLOS Digit Health. 2026 May 14;5(5):e0001360.
Ng JH, Wei Yang Teo N, Forde C, Lamoureux EL, Gupta P. Elucidating the Burden of Dual-sensory Impairment in Community-based Older Individuals in a Multi-ethnic Society. Sci Rep. 2026 Apr 2;16(1):16650.
Jha D, Zhou Y, Praveen AD, Galliker ES, Gupta P, Lamoureux EL, Hong N, Rhee Y, Pálsson H, Ferguson SJ, Helgason B. DXA-derived Biofidelic Finite Element Models for Quantifying the Efficacy of Hip Protectors. JBMR Plus. 2026 Apr 14;10(6):ziag067.
Au Eong JTW, Low JR, Fenwick EK, Htoon HM, Perera SA, Wong TT, Lamoureux EL, Man REK. Effect of Combined Cataract and Minimally Invasive Glaucoma Surgeries on Glaucoma-specific Quality of Life. J Clin Med. 2026 Feb 4;15(3):1215.
Yee H, Wong CMJ, Gupta P, Thakur S, Fenwick E, Lamoureux EL, Man REK. Prevalence, Risk Determinants, and Burden of Undiagnosed Age-related Eye Diseases Among Older Asian Adults. JAMA Ophthalmol. 2026 Jan 1;144(1):23-32.
Zhang Y, Gupta P, Fenwick E, Man R, Wong CMJ, Tan ACS, Cheung CMG, Colega MT, Chong MF, Lai JS, Lamoureux EL. The Association of Dietary Patterns with Age-related Macular Degeneration in a Multi-ethnic Older Singaporean Population. Ophthalmologica. 2026 Jan 17:1-16.
Cheong KX, Chi M, Pan W, Lee YQ, Zhang Y, Hu Z, Htoon HM, Hoang QV, Chong MF, Lan W, Saw SM, Lamoureux EL. Diet and Myopic Macular Degeneration in the Aier-SERI High Myopia Adult Cohort Study. Acta Ophthalmol. 2025 Dec;103(8):891-899.
Yeo BSY, Song HJJMD, Tan BKJ, Suresh A, Ho OTW, Chan JH, Gao EY, Tan CJ, Teo CB, Chen CL, Tay L, Lamoureux EL, Hummel T, See A, Xu S, Toh ST, Charn TC, Teo NWY. Olfactory Impairment and Incident Cognitive Decline: A Systematic Review and Meta-analysis. Int Forum Allergy Rhinol. 2025 Dec;15(12):1347-1358.
Soh ZD, Bai Y, Yu K, Zhou Y, Lei X, Thakur S, Lee Z, Phang LCL, Peng Q, Xue CC, Chong RS, Hoang QV, Raghavan L, Tham YC, Sabanayagam C, Wu WC, Ho MC, He J, Gupta P, Lamoureux E, Saw SM, Nangia V, Panda-Jonas S, Xu J, Wang YX, Xu X, Jonas JB, Wong TY, Goh RSM, Liu Y, Cheng CY. An Integrated Language-vision Foundation Model for Conversational Diagnostics and Triaging in Primary Eye Care. Cell Rep Med. 2025 Dec 4:102476.
Jha D, Chandran M, Koller D, Cheong VS, Praveen AD, Baker A, Gupta P, Lamoureux EL, Pálsson H, Ferguson SJ, Helgason B. Relationship Between Areal BMD, FRAX®, and Femoral Strength in Community-dwelling Older Asian Adults. Arch Osteoporos. 2025 Nov 4;20(1):139.
Tham YC, Goh JHL, Nderitu P, Zhou Y, Ran AR, Srinivasan S, Yang GD, Kitema GF, Rawlinson P, Jiang H, Zou K, Cheung CY, Keane PA; Global RETFound Consortium. Building the World's First Truly Global Medical Foundation Model. Nat Med. 2025 Nov;31(11):3580-3585.
Jha D, Praveen AD, Baker A, Fung A, Cheong VS, Gupta P, Lamoureux EL, Hong N, Rhee Y, Koh VJW, Pálsson H, Taylor WR, Chan AW, Ferguson SJ, Helgason B. Dual-energy X-ray Absorptiometry Based Biofidelic Finite Element Models for Simulating Falls to the Hip: Impact of Trochanteric Soft Tissue Thickness on Fracture Risk. Clin Biomech (Bristol). 2025 Nov 21:106720.
Piccoli G, Fenwick EK, Bucceri V, Lamoureux EL, Tagliabue E, Nucci P, Vujosevic S. Impact of Vision Impairment and Microperimetry Parameters on Quality of Life in Patients with Center-involving Diabetic Macular Edema. Ophthalmol Sci. 2025 Nov 10;6(2):101001.
Matsumura S, Fenwick EK, Kawakami M, Takagi S, Lamoureux EL, Hori Y. Psychometric Evaluation of the Japanese Version of the Impact of Vision Impairment (IVI) Questionnaire using Rasch Analysis. Asia Pac J Ophthalmol (Phila). 2025 Nov-Dec;14(6):100204.
Gao EY, Tan BKJ, Chan KL, Chia CXY, Tan CJ, Yeo BSY, Liu X, Tay L, Lamoureux EL, Teo NWY, Charn TC. Chronic Rhinosinusitis and Cognition: A Systematic Review and Meta-analysis. Rhinology. 2025 Oct 1;63(5):514-522.
Pan W, Man REK, Fenwick EK, Hu Z, Jiang Y, Tan H, Chen Z, Hoang QV, Saw SM, Lamoureux EL, Lan W, Yang Z. A Psychometric Evaluation of the Chinese Impact of Vision Impairment (C-IVI) Questionnaire in an Adult Cohort with High Myopia Using Rasch Analysis. PLoS One. 2025 Oct 9;20(10):e0327708.
Gupta P, Thakur S, Wong CMJ, Man REK, Fenwick EK, Sabanayagam C, Huang O, Low JR, Perera SA, Wong TT, Lamoureux EL. Glaucoma in Older Asians Aged 60 to 100 Years: Prevalence, Factors, Trends, and Projections (2024-2040). Invest Ophthalmol Vis Sci. 2025 Jul 1;66(9):62.